Council on Aging Answers 2017 - 88

COUNCIL ON AGING - SOUTHERN CALIFORNIA

Medicare Advantage Plans Comparison Chart
CENTRAL HEALTH
MEDICARE PL.
Central Health
Premier Plan
H5649-004

SIZE OF NETWORK
OUT OF POCKET MAXIMUM
DOCTOR/SPECIALIST VISIT

New enrollment:
866-314-2427
Current Members:
866-314-2427
centralhealthplan.com
MA-PD (HMO)
Medi-Medi option offered
$36.20 monthly premium
health plan deduct.: unavail.
$400 drug plan deductible
4501-5000 providers
$6,700 In-Network
20%/20% of cost each visit

IN-PATIENT HOSPITALIZATION

Contact plan for details.

TELEPHONE NUMBERS
AND WEBSITE
PLAN TYPE
TOTAL MONTHLY PREMIUM
& ANNUAL DEDUCTIBLES

SKILLED NURSING FACILITY
AMBULANCE
CHEMOTHERAPY DRUGS
CHIROPRACTIC
DIABETES

DIAGNOSTIC TESTS, LAB &
RADIOLOGY SERVICES,
AND X-RAYS
DURABLE MEDICAL EQUIPMENT
EMERGENCY ROOM VISIT
OUTPATIENT HOSPITAL SERVICES
OUTPATIENT REHAB SERVICES
TRANSPORTATION
DENTAL SERVICES
(SEE NOTES FOR *)

HEARING SERVICES
(SEE NOTES FOR **)

VISION SERVICES
(SEE NOTES FOR ***)

100 days each benefit period. Contact
plan for more details.
20% of cost each service
20% of cost for Part B chemotherapy
drugs

EASY CHOICE HEALTH PLAN

GOLDEN STATE

Easy Choice Plus Plan
H5087-002

Easy Choice Best Plan
H5087-005

Golden State
Medicare Health Plan,
Golden
H2241-006

New enrollment:
866-999-3945
Current Members:
866-999-3945
easychoicehealthplan.com
MA-PD (HMO)
Medi-Medi option offered

New enrollment:
866-999-3945
Current Members:
866-999-3945
easychoicehealthplan.com

New enrollment:
877-541-4111
Current Members:
877-541-4111
gsmhp.com

MA-PD (HMO)

$27 monthly premium
$400 drug plan deductible

$0 monthly premium

$4.40 monthly premium

4501-5000 providers
$6,700 In-Network
$0/20% of cost each visit

12001-13000 providers
$3,400 In-Network
$0/$0 each visit

4501-5000 providers
$3,400 In-Network
$10/$15 each visit

Days 1-3: $500/day, Days 4-90: $0/day.
$0/day for additional 120 days.

Days 1-90: $0/day. $0/day for 120
additional days.

$300 copay. Unlimited days each benefit
period.

Days 1 -20: $0/day, Days 21-100: $50/day.
100 days each benefit period.
$50 each service
20% of cost for Part B chemotherapy
drugs

Days 1-20: $0/day, Days 21-100: $50/day.
100 days covered each benefit period.
$200 each service
20% of cost for Part B chemotherapy
drugs

$0 for subluxation manipulation

Days 1-20: $0/day, Days 21-100: $164.50/
day. 100 days each benefit period.
20% of cost each service
20% of cost for Part B chemotherapy
drugs
20% of cost for subluxation
$0 for subluxation manipulation
manipulation. $0 for routine visit.
$0 for monitoring supplies. $0 for self- $0 for monitoring supplies. $0 for selfmanagement training. $0 for therapeutic management training. 20% of cost for
shoes or inserts.
therapeutic shoes or inserts.
20% of cost for diagnostic radiology
20% of cost for diagnostic radiology
services. 20% of cost for diagnostic tests services. $0 for diagnostic tests and
and procedures. 20% of cost for lab
procedures. $0 for lab services. $0
services. 20% of cost each x-ray. 20% of each x-ray. 20% of cost for therapeutic
cost for therapeutic radiology services. radiology services.
20% of cost of Medicare- covered items 20% of cost of Medicare- covered items
20% of cost each visit, waived if admitted $75 each visit, waived if admitted within
within 24 hours.
24 hours.
20% of cost each visit
20% of cost each visit
20% of cost each occupational or cardiac
visit.
20% of cost each visit
$0 each all other visits.
$0 copay
$0 copay
$0 for limited dental. $0 for cleaning.
20% of cost for limited dental. $0 for
$0 for x-rays. $0 for fluoride treatment. cleaning. $0 for x-rays. $0 for fluoride
$0 for oral exam. Contact plan for
treatment. $0 for oral exam. Contact plan
comprehensive services.
for comprehensive services
20% of cost for diagnostic exam. $0 for 20% of cost for diagnostic exam. $0 for
routine hearing exam. $0 for hearing aid routine hearing exam. $0 for hearing aid
fitting or evaluation. $0 for hearing aid. fitting or evaluation. $0 for hearing aid.
Plan pays up to $2,000 for hearing aids. Plan pays up to $1,000 for hearing aids.
20% of cost for diagnostic exam. $0 for
20% of cost for diagnostic exam. $0 for
routine eye exam. $0 for contact lenses.
routine eye exam. $0 for contact lenses.
$0 for eyeglasses. $0 for eyeglass frames.
$0 for eyeglasses. $0 for eyewear after
$0 for eyeglass lenses. $0 for eyewear
cataract surgery. Plan pays up to $300
after cataract surgery. Plan pays up to
for eyewear.
$350 for eyewear.

$0 for monitoring supplies.
$0 for monitoring supplies. $0 for self$0 for self-management training. 20% of management training. $0 for therapeutic
cost for therapeutic shoes or inserts.
shoes or inserts.
$0 for diagnostic radiology services. $0
for diagnostic tests and procedures. $0
for lab services. $0 each x-ray. 20% of
cost for therapeutic radiology services.

$0 for diagnostic radiology services. $0
for diagnostic tests and procedures. $0
for lab services. $0 each x-ray. $0 for
therapeutic radiology services.

20% of cost of Medicare- covered items
$75 each visit, waived if admitted within
24 hours.
$50 each visit

0-20% of cost of Medicare-covered items
$75 each visit, waived if admitted within
24 hours.
$100 each visit

$0 each visit

$0 copay
$0 for limited dental. $10-$55 for
cleaning. $0-$30 for x-rays. $9-$20 for
fluoride treatment. $0-$40 for oral exam.
Contact plan for comprehensive services.
$0 for diagnostic exam. $0 for routine
hearing exam. $0 for hearing aid fitting
or evaluation. $0 for hearing aid. Plan
pays up to $1,000 for hearing aids.
$0 for diagnostic exam.
$0 for routine eye exam. $0 for contact
lenses. $0 for eyeglasses. $0 for eyeglass
frames. $0 for eyeglass lenses. $0 for
eyewear after cataract surgery. Plan pays
up to $200 for eyewear.

$0 copay
$0 for limited dental. $8 for cleaning.
$8 for x-rays. $8 for fluoride treatment.
$8 for oral exam. Contact plan for
comprehensive services.
$0 for diagnostic exam. $0 for routine
hearing exam. $0 for hearing aid fitting
or evaluation. $0 for hearing aid. Plan
pays up to $400 for hearing aids.
$0 for diagnostic exam. $0 for routine
eye exam. $0 for contact lenses. $0
for eyeglasses. $0 for eyewear after
cataract surgery. Plan pays up to $150
for eyewear.

Confused by Medicare? Call the Council on Aging - Southern California HICAP experts at (800) 434-0222
88

Answers Guide 2017

THE INFORMATION ON THESE CHARTS IS SUBJECT TO CHANGE. Contact the plan to verify information.

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REFERENCES
WHERE APPROPRIATE.

http://www.centralhealthplan.com http://www.easychoicehealthplan.com http://www.easychoicehealthplan.com http://www.gsmhp.com

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